Neuropathic painful complications due to endopelvic nerve lesions after robot-assisted laparoscopic prostatectomy: Three case reports

Femoral and obturator neuropathies

The femoral and obturator nerves both arise from the L2, L3, and L4 spinal nerve roots and descend into the pelvis before emerging in the lower limbs. The femoral nerve's primary function is knee extension and hip flexion, along with some sensory innervation to the leg. The obturator nerve's primary function is thigh adduction and sensory innervation to a small area of the medial thigh. Each may be injured by a variety of potential causes, many of them iatrogenic. Here, we review the anatomy of the femoral and obturator nerves and the clinical features and potential etiologies of femoral and obturator neuropathies. Their necessary investigations, including electrodiagnostic studies and imaging, their prognosis, and potential treatments, are discussed in this chapter.

Laparoscopic Photoacoustic Imaging System Based on Side-Illumination Diffusing Fibers

OBJECTIVE

To develop a flexible miniaturized photoacoustic (PA) imaging probe for detecting anatomical structures during laparoscopic surgery. The proposed probe aimed to facilitate intraoperative detection of blood vessels and nerve bundles embedded in tissue not directly visible to the operating physician to preserve these delicate and vital structures.

METHODS

We modified a commercially available ultrasound laparoscopic probe by incorporating custom-fabricated side-illumination diffusing fibers that illuminate the probe's field of view. The probe geometry, including the position and orientation of the fibers and the emission angle, was determined using computational models of light propagation in the simulation and subsequently validated through experimental studies.

RESULTS

In wire phantom studies within an optical scattering medium, the probe achieved an imaging resolution of 0.43 ±0.09 mm and a signal-to-noise ratio of 31.2±1.84 dB. We also conducted an ex vivo study using a rat model, demonstrating the successful detection of blood vessels and nerves.

CONCLUSION

Our results indicate the viability of a side-illumination diffusing fiber PA imaging system for guidance during laparoscopic surgery.

SIGNIFICANCE

The potential clinical translation of this technology could enhance the preservation of critical vascular structures and nerves, thereby minimizing post-operative complications.

Nursing Intervention Countermeasures of Robot-Assisted Laparoscopic Urological Surgery Complications

The objective is to explore the application effect of comprehensive nursing intervention in prevention of lower extremity deep vein thrombosis and pulmonary embolism in urological patients undergoing laparoscopic and robot-assisted laparoscopic surgery. From April 2019 to April 2020, 200 patients who received urological laparoscopic surgery and robot-assisted laparoscopic surgery were selected. According to the random number table method, they were divided into control group and observation group, 100 cases in control group and 100 cases in observation group. Patients in control group received routine nursing, while patients in observation group received comprehensive nursing intervention. The skin condition, swelling, pain, and occurrence of deep venous thrombosis and pulmonary embolism of lower extremities in 2 groups were observed. The experimental results showed that the lower limb swelling, lower limb pain, and lower limb deep vein thrombosis in the control group were significantly higher than those in the observation group, but all patients were cured and discharged after taking effective symptomatic treatment and nursing measures in time. In the control group, pulmonary embolism occurred in 3 patients, all of whom died. There was no significant difference in skin changes of lower limbs (P > 0.05), and there were significant differences in other skin changes (P < 0.05). It proved that comprehensive nursing intervention can effectively prevent the formation of lower extremity deep vein thrombosis and pulmonary embolism in urological patients undergoing laparoscopic and robot-assisted laparoscopic surgery with high-risk factors.

Solitary Fibrous Tumor of the Prostate: A Case Report and Literature Review

Solitary fibrous tumors (SFTs) usually occur in the pleura and account for two-thirds of all cases; however, SFTs occurring in the prostate are extremely rare. Approximately 25 cases have been reported in the literature to date. This study reports the case of a 43-year-old man referred to our hospital with the chief complaint of a pelvic tumor after careful examination. The tumor marker levels were within normal limits. T2-weighted magnetic resonance imaging revealed a tumor, demonstrating primarily low signal intensity. It showed a capsule-like rim at the left lobe of the prostate, suggesting that the tumor was partially invading the rectal wall. Histopathological examination of needle-core biopsies showed spindle cell neoplasm with small and fusiform cells, strongly expressing signal transducer and activator of transcription 6 (STAT6) with a ramifying vascular network. Therefore, the clinical diagnosis of the patient was SFT of the prostate and robot-assisted radical prostatectomy was performed. Histopathological examination revealed that the tumor was composed of spindle cells with patternless and staghorn patterns. Immunohistochemical analysis showed a strong expression of STAT6. Furthermore, the tumor was partially positive for CD34. Therefore, the patient was diagnosed with SFT of the prostate. Two years after the initial diagnosis, the patient was alive with normal erectile function, continence status, and no evidence of the disease.

Oral Pregabalin in Cardiac Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background

Pregabalin has received wide clinical attention as a new type of analgesic. We undertake a systematic review and meta-analysis to evaluate the effect of pregabalin on postoperative pain in patients undergoing cardiac surgery.

Methods

We searched PubMed, Embase, and Cochrane Library (from inception to July 2020) for eligible studies. The primary outcomes were the total morphine consumption at 24 h. A secondary outcome was intraoperative fentanyl consumption, extubation time postoperative, and length of stay in hospital. We calculated pooled weighted mean difference (WMD) or odds ratio (OR) and 95% CIs using random- or fixed-effects models.

Results

Seven trials involving 463 patients were listed. Meta-analysis showed that the total morphine consumption at 24 h in the pregabalin group was significantly less than the control group (WMD: -5.44, 95% CI: -10.42–0.46, P = 0.03). We found that there is no significant difference between the two groups in intraoperative fentanyl consumption. Compared with the control group, the length of stay in hospital in the pregabalin group was significantly shorter (WMD = -0.87, 95% CI: -1.42−0.32, P = 0.002). And we found that there were no significant differences between the two groups in extubation time (WMD: 17.24, 95% CI: -24.36−58.84, P = 0.42).

Conclusions

Oral pregabalin for cardiac surgery patients can effectively reduce the patient's 24-hour morphine consumption after surgery, shorten the patient's hospital stay, and is more conducive to early postoperative recovery.